Resumen La Ley Nacional de Trasplantes en Colombia, Ley 1805 de 2016, modificó la legislación colombiana en cuanto a cómo se accede a un trasplante de órganos, pero, sobre todo, cambió la figura de donatario y dispuso el término derivado del derecho del consentimiento presuntivo. Este define la hipotética voluntad de una persona de ser donante de órganos como manifestación de solidaridad y beneficencia con otra persona en situación de necesidad y vulnerabilidad relacionada con su salud y las dimensiones que la definen. En el siguiente texto se presentan siete momentos que se consideran hechos fundamentales en la construcción de una cultura del valor de la atención en salud en la política nacional de trasplantes de Colombia.

Abstract The national transplant law in Colombia, Law 1805 of 2016, modified the Colombian legislation regarding how a person accesses an organ transplant, but above all, it changed the donor figure, establishing the term derived from the presumptive consent right. This term implies a person’s hypothetical willingness to be an organ donor as a manifestation of solidarity and charity towards another person in a situation of need and vulnerability concerning his/her health and the dimensions that define it. In the following text, seven moments are considered fundamental facts when constructing a culture about the value of healthcare in the national transplant policy in Colombia.

Resumen El examen de rutina de los donantes de órganos para detectar la infección por el virus de la inmunodeficiencia humana (HIV) ha hecho que la transmisión del virus mediante el trasplante de órganos sea poco común. Sin embargo, a pesar de las pruebas de detección de rutina, la transmisión del HIV continúa siendo un riesgo del trasplante de órganos ya que, a diferencia de los tejidos, los órganos sólidos no se pueden procesar, desinfectar, ni modificar para inactivar patógenos infecciosos. A continuación, se describe un caso de posible transmisión de HIV por trasplante de órganos de un donante previamente seronegativo a dos de sus receptores.

Abstract Routine screening of organ donors to detect human immunodeficiency virus (HIV) infection has detected the rare transmission of the virus through organ transplantation. However, despite routine screening, HIV transmission remains a risk in organ transplantation since, unlike tissues, solid organs cannot be processed, disinfected, or modified to inactivate infectious pathogens. A case of possible transmission of HIV by organ transplant is described below, from a previously seronegative donor to two recipients.

Abstract Introduction. The critical pathway for deceased donation offers a methodical framework for guiding the donation process. It not only serves to assess performance but also to identify areas of potential improvement. Therefore, the identification and selection of potential organ donors (POD) is a key process. This study aims to describe the critical pathway for deceased donation in a cohort of POD in three regions (CRT1, CRT2, and CRT5) of Colombia. Methods. We retrospectively reviewed data of POD assessed from January 2022 to December 2022. General characteristics of POD, diagnosis, contraindication causes, and organ procurement were described. Analysis was conducted using the Chi-squared test for categorical variables and the Mann-Whitney test for quantitative variables. Results. Within the cohort of 1451 assessed POD, 441 (30.3%) were diagnosed with brain death. Among potential donors after brain death, 198 (44.9%) were eligible donors (medically suitable). Of these, 157 donors (79.3%) became actual donors (undergoing operative incision for organ recovery), with 147 (93,6 %) having at least one organ recovered (actual donors with organ recovery). Ultimately, 411 utilized organs were utilized. Additionally, there were observed differences in the characteristics of donors from different regions. Conclusion. This study reports the critical pathway for deceased donation in a cohort of POD in three regions of Colombia. This provides useful information and helps to gain insight and understanding into the process of organ donation and organ procurement in order to take actions that could improve the donation rates.

Resumen Introducción. La ruta crítica de donantes fallecidos permite un enfoque sistemático para la donación de riñón, y, proporciona una herramienta para evaluar el rendimiento de áreas de mejora potencial. La selección de posibles donantes de órganos (PDO) es un proceso clave. El objetivo de este estudio fue describir la ruta crítica para la donación de fallecidos en una cohorte de PDO en tres regiones de Colombia. Métodos. Estudio retrospectivo de PDO evaluados durante 2022. Se describieron las características generales de los PDO, el diagnóstico y las causas de contraindicación. El análisis se llevó a cabo utilizando la prueba de Chi-cuadrado para las variables categóricas y la prueba de Mann-Whitney para las variables cuantitativas. Resultados. Entre los 1451 POD evaluados, 441 (30,3 %) fueron diagnosticados con muerte cerebral. De los posibles donantes después de la muerte cerebral, 198 (44,9 %) fueron donantes elegibles (adecuados desde el punto de vista médico). Entre ellos, 157 donantes (79,3 %) fueron donantes reales (en quienes se realizó una incisión operatoria con la intención de recuperar órganos) y 147 (93,6 %) tuvieron al menos un órgano recuperado (donantes reales con recuperación de órganos). Finalmente, se identificaron 411 órganos utilizados. Conclusión. Este estudio reporta la ruta crítica para la donación de fallecidos en una cohorte de POD en tres regiones de Colombia. Esto proporciona información útil, ayuda a obtener conocimientos y comprender el proceso de donación y obtención de órganos, para tomar medidas que puedan mejorar las tasas de donación.

RESUMEN Introducción: A lo largo de los años se ha propuesto una notable variedad de protocolos quirúrgicos periodontales, cuyo enfoque pasó de la simple resolución de defectos de tejidos blandos a la realización de procedimientos predecibles y mínimamente invasivos. Inicialmente se usaba el injerto gingival libre. Posteriormente se han probado diversas técnicas, incluidas aquellas con sustitutos de tejidos blandos, como membranas tipo Alloderm. Hoy en día se considera el gold standard el injerto de tejido conectivo subepitelial asociado al colgajo de avance coronal. Por último, se ha examinado la técnica Pinhole, con mayor preservación de tejido y resultado más estético. Objetivos: El objetivo de esta revisión fue la comparación de técnicas actualizadas para el tratamiento de recesiones múltiples en maxilar superior e inferior. El resultado del procedimiento se evaluó en términos de cobertura radicular completa, reducción de la recesión, ganancia en altura y volumen, resultado estético, dolor postoperatorio y morbilidad del lecho donante y receptor del paciente. Material y métodos: Se realizaron búsquedas electrónicas y manuales para recopilar estudios de boca dividida, ensayos clínicos controlados aleatorios, series de casos, estudios piloto, libros de periodoncia, estudios de casos, revisiones sistemáticas y metanálisis, incluyendo los defectos de recesiónes gingivales múltiples, en maxilar y mandibular, de las cuatro clases de Miller, debido a su extensa evidencia. Resultados: Se incluyeron treinta y cuatro publicaciones y se extrajeron datos sobre el resultado de las técnicas quirúrgicas de dieciocho artículos. La evaluación clínica analizó la cantidad de cobertura radicular completa, la reducción de la recesión y la ganancia de altura y volumen, mientras que la perspectiva del paciente se expresó en términos de satisfacción estética y posibles complicaciones postoperatorias. Los procedimientos de los últimos diez años mostraron mejores resultados en todos los factores mencionados anteriormente. Conclusión: La predictibilidad y la estabilidad del tratamiento a largo plazo representan los factores que guían el proceso de elección de la técnica y que añaden valor a los procedimientos más actualizados. Se observaron progresos tanto a nivel estético, al reducir las discrepancias entre el área intervenida y el tejido circundante, como a nivel postoperatorio, al aminorar las molestias del paciente. Los desafíos propios de esta rama pronto podrían encontrar respuesta gracias a su rápida evolución, la cual permite concebir más avances.

ABSTRACT Background: Along the years, a remarkable variety of periodontal surgical protocols has been proposed, the focus of which has shifted from the mere resolution of a soft tissue defect to the performance of predictable and minimally invasive procedures. Initially, the free gingival graft was used. Subsequently, many different techniques were experimented, including those using soft tissue substitutes, such as the Alloderm membrane. Nowadays, the association of the connective tissue graft with the coronally advanced flap is considered the gold standard. Finally, the Pinhole technique, being a more conservative method in terms of tissue preservation and aesthetic outcome, was proposed. Objectives: The aim of this review was the comparison of the updated techniques for the treatment of multiple periodontal recessions, affecting both maxilla and mandible. The procedure outcome was assessed in terms of complete root coverage, recession reduction, gain in height and volume, aesthetic outcome, patient’s post-operative pain and morbidity of donor and recipient sites. Material and methods: Electronic and hand searches were performed to collect split- mouth studies, randomized controlled clinical trials, case series, pilot studies, periodontal books, case studies, systematic reviews and meta-analysis, including maxillary and mandibular multiple gingival recession defects of all four Miller’s classes, for its extensive evidence. Results: Thirty-four publications were included and data regarding the surgical techniques outcome were extracted from eighteen articles. The clinical evaluation analyzed the amount of complete root coverage, recession reduction and gain in height and volume, while the patient’s perspective was expressed in terms of aesthetic satisfaction and possible postoperative complications. Procedures in the last ten years showed better results in all the above-mentioned factors. Conclusion: Procedural predictability and long-lasting treatment stability embody the factors driving the technique election process and adding value to more updated procedures. Progress was observed both at an aesthetic level, by reducing the discrepancias between the surgical region and the surrounding tissue, and at a postoperative level, by reducing patient discomfort. The challenges inherent to this branch could soon find answers thanks to its prompt evolution, which allows for further advances to be conceived.

RESUMEN Introducción: A lo largo de los años se ha propuesto una notable variedad de protocolos quirúrgicos periodontales, cuyo enfoque pasó de la simple resolución de defectos de tejidos blandos a la realización de procedimientos predecibles y mínimamente invasivos. Inicialmente se usaba el injerto gingival libre. Posteriormente se han probado diversas técnicas, incluidas aquellas con sustitutos de tejidos blandos, como membranas tipo Alloderm. Hoy en día se considera el gold standard el injerto de tejido conectivo subepitelial asociado al colgajo de avance coronal. Por último, se ha examinado la técnica Pinhole, con mayor preservación de tejido y resultado más estético. Objetivos: El objetivo de esta revisión fue la comparación de técnicas actualizadas para el tratamiento de recesiones múltiples en maxilar superior e inferior. El resultado del procedimiento se evaluó en términos de cobertura radicular completa, reducción de la recesión, ganancia en altura y volumen, resultado estético, dolor postoperatorio y morbilidad del lecho donante y receptor del paciente. Material y métodos: Se realizaron búsquedas electrónicas y manuales para recopilar estudios de boca dividida, ensayos clínicos controlados aleatorios, series de casos, estudios piloto, libros de periodoncia, estudios de casos, revisiones sistemáticas y metanálisis, incluyendo los defectos de recesiónes gingivales múltiples, en maxilar y mandibular, de las cuatro clases de Miller, debido a su extensa evidencia. Resultados: Se incluyeron treinta y cuatro publicaciones y se extrajeron datos sobre el resultado de las técnicas quirúrgicas de dieciocho artículos. La evaluación clínica analizó la cantidad de cobertura radicular completa, la reducción de la recesión y la ganancia de altura y volumen, mientras que la perspectiva del paciente se expresó en términos de satisfacción estética y posibles complicaciones postoperatorias. Los procedimientos de los últimos diez años mostraron mejores resultados en todos los factores mencionados anteriormente. Conclusión: La predictibilidad y la estabilidad del tratamiento a largo plazo representan los factores que guían el proceso de elección de la técnica y que añaden valor a los procedimientos más actualizados. Se observaron progresos tanto a nivel estético, al reducir las discrepancias entre el área intervenida y el tejido circundante, como a nivel postoperatorio, al aminorar las molestias del paciente. Los desafíos propios de esta rama pronto podrían encontrar respuesta gracias a su rápida evolución, la cual permite concebir más avances.

ABSTRACT Background: Along the years, a remarkable variety of periodontal surgical protocols has been proposed, the focus of which has shifted from the mere resolution of a soft tissue defect to the performance of predictable and minimally invasive procedures. Initially, the free gingival graft was used. Subsequently, many different techniques were experimented, including those using soft tissue substitutes, such as the Alloderm membrane. Nowadays, the association of the connective tissue graft with the coronally advanced flap is considered the gold standard. Finally, the Pinhole technique, being a more conservative method in terms of tissue preservation and aesthetic outcome, was proposed. Objectives: The aim of this review was the comparison of the updated techniques for the treatment of multiple periodontal recessions, affecting both maxilla and mandible. The procedure outcome was assessed in terms of complete root coverage, recession reduction, gain in height and volume, aesthetic outcome, patient’s post-operative pain and morbidity of donor and recipient sites. Material and methods: Electronic and hand searches were performed to collect split- mouth studies, randomized controlled clinical trials, case series, pilot studies, periodontal books, case studies, systematic reviews and meta-analysis, including maxillary and mandibular multiple gingival recession defects of all four Miller’s classes, for its extensive evidence. Results: Thirty-four publications were included and data regarding the surgical techniques outcome were extracted from eighteen articles. The clinical evaluation analyzed the amount of complete root coverage, recession reduction and gain in height and volume, while the patient’s perspective was expressed in terms of aesthetic satisfaction and possible postoperative complications. Procedures in the last ten years showed better results in all the above-mentioned factors. Conclusion: Procedural predictability and long-lasting treatment stability embody the factors driving the technique election process and adding value to more updated procedures. Progress was observed both at an aesthetic level, by reducing the discrepancias between the surgical region and the surrounding tissue, and at a postoperative level, by reducing patient discomfort. The challenges inherent to this branch could soon find answers thanks to its prompt evolution, which allows for further advances to be conceived.

Introdução: Recentes progressos feitos na bioengenharia de enxertos cardíacos oferecem nova modalidade terapêutica para a regeneração do tecido cardíaco pós-infarto do miocárdio. O CD34 é marcador que expressa todas as células precursoras hematopoiéticas e endoteliais, e funciona como fator de adesão celular. O anticorpo que correspondente a este marcador é utilizado na imunoistoquímica para avaliar a formação de novos vasos e a presença de células-tronco. Objetivo: Avaliar a eficácia da omentopexia na neovascularização e células-tronco. Métodos:  Revisão colhendo informações publicadas em plataformas virtuais selecionadas (SciELO – Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus).  A busca iniciou-se por descritores relacionados ao tema, identificados por meio do DeCS/MESH nos seguintes descritores: “isquemia miocárdica; revascularização miocárdica; omentopexia; imunoistoquímica; CD34; células-tronco” e seus equivalentes em inglês: “stem cell; myocardial ischemia; myocardial revascularization; omentopexy; immunohistochemistry; CD34”. Foram lidos pelo título e resumo, com busca AND ou OR seguindo-se da leitura na íntegra daqueles com maior relação ao tema. Foram incluídos o total de 23 artigos. Resultados: O omento maior tem propriedade clínica marcante em conter sítios de danos teciduais. Ele aumenta seu volume tecidual em resposta às partículas estranhas e inflamatórias envolvendo diversas células imunomoduladoras com células progenitoras, em um processo chamado “ativação do omento”. Conclusão: A cárdio-omentopexia associada à abrasão mecânica e perfurações miocárdicas, mostra ser eficiente na indução de neovascularização. O omento maior promove células-tronco - confirmadas pelo CD34 -, demonstrando grande potencial como futura terapêutica para restaurar áreas de miocárdio isquêmico.

Introduction: Recent progress in the bioengineering of cardiac grafts offers a new therapeutic modality for the regeneration of cardiac tissue after myocardial infarction. CD34 is a marker that expresses all hematopoietic and endothelial precursor cells, and functions as a cell adhesion factor. The antibody corresponding to this marker is used in immunohistochemistry to evaluate the formation of new vessels and the presence of stem cells. Objective: To evaluate the effectiveness of omentopexy in neovascularization and stem cells. Methods: Review collecting information published on selected virtual platforms (SciELO – Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus). The search began with descriptors related to the topic, identified through DeCS/MESH in the following: “myocardial ischemia; myocardial revascularization; omentopexy; immunohistochemistry; CD34; stem cells”. They were read by title and summary, with an AND or OR search followed by the full reading of those most closely related to the topic. A total of 23 articles were included. Results: The greater omentum has a remarkable clinical property in containing sites of tissue damage. It increases its tissue volume in response to foreign and inflammatory particles involving several immunomodulatory cells with progenitor cells, in a process called “omentum activation”. Conclusion: Cardio-omentopexy associated with mechanical abrasion and myocardial perforations proves to be efficient in inducing neovascularization. The greater omentum promotes stem cells - confirmed by CD34 -, demonstrating great potential as a future therapy to restore areas of ischemic myocardium.

Abstract Objective: Kidney transplant (KTx) recipients have a high burden of comorbidities and are at increased risk of death from coronavirus disease 2019 (COVID-19). Our objective is to describe the clinical manifestations and outcomes in a group of KTx recipients with COVID-19 and to define factors associated with mortality. Methods: Cross-sectional study that included the retrospective review of clinical records of KTx recipients diagnosed with COVID-19 between March 2020 and February 2022 in a transplant center in Bogotá (Colombia). A bivariate and multivariate analysis was performed to establish associations between the variables of interest and the primary outcome (mortality). Results: Ninety-four cases were included. 71.28% had a KTx, mainly from a cadaveric donor. Clinical manifestations included cough in 79.7%, fever in 50%, and dyspnea in 42.55% of cases. The overall mortality rate was 18.09%. In 54.9% an immunosuppressive adjustment was made, with complete interruption of the scheme in up to 74% of these cases. Conclusions: The mortality rate evidenced in KTx recipients with COVID-19 is higher than in general population. The severity of the COVID-19 in this group frequently requires adjustments to immunosuppressive therapy. The factors associated with mortality were dyspnea, the need for orotracheal intubation and intensive care unit stay.

Resumen Objetivo: Los pacientes receptores de trasplante renal (TxR) tienen alta carga de comorbilidades y un riesgo aumentado de muerte por COVID-19. Nuestro objetivo es describir las manifestaciones y los desenlaces clínicos en un grupo de receptores de TxR con enfermedad por coronavirus 2019 (COVID-19) y definir factores asociados a mortalidad. Métodos: Estudio de corte transversal que incluyó la revisión retrospectiva de registros clínicos de pacientes receptores de TxR y diagnóstico de COVID-19 entre marzo de 2020 y febrero de 2022 en un centro de alta complejidad en Bogotá (Colombia). Se ejecutó un análisis bivariante y multivariante para establecer asociaciones entre las variables de interés y el desenlace en mortalidad. Resultados: Se incluyeron un total de 94 casos. El 71,28% tenía un TxR, principalmente de donante cadavérico. Las manifestaciones clínicas incluyeron la tos en el 79,7%, fiebre en el 50% y disnea en el 42,55% de los casos. La tasa de mortalidad global fue del 18,09%. En el 54,9% se realizó un ajuste inmunosupresor, con interrupción completa del esquema hasta en el 74% de estos casos. Conclusiones: La tasa de mortalidad evidenciada en receptores de TxR con COVID-19 es mayor que la descrita en la población general. La severidad de la COVID-19 en este grupo poblacional implica de forma frecuente la necesidad de ajustes a la terapia inmunosupresora. Los factores asociados a mortalidad fueron la disnea, la necesidad de intubación orotraqueal y de estancia en unidad de cuidados intensivos.

RESUMEN Objetivo. Presentar una descripción integral de la donación, utilización y descarte de órganos en todo el proceso de donación en Colombia. Métodos. Estudio retrospectivo de 1 451 donantes posibles, distribuidos en tres regiones de Colombia, que fueron evaluados en el 2022. Se describen las características generales, el diagnóstico y las causas de contraindicación de los donantes potenciales. Resultados. De los 1 451 donantes posibles, 441 (30,4%) cumplían con los criterios de muerte encefálica y constituyeron el conjunto de donantes potenciales. Las familias consintieron la donación de órganos en 141 casos aptos desde el punto de vista médico, mientras que en 60 casos se recurrió a la presunción legal, con lo que se llegó a 201 donantes aptos (13,9%). De estos, 160 (11,0%) fueron donantes reales (en los que se les practicó una incisión quirúrgica para la extracción de órganos o se obtuvo al menos un órgano). En última instancia, hubo 147 donantes utilizados (10,1%) (de los que se trasplantó al menos un órgano). Se observaron diferencias estadísticamente significativas entre las regiones en cuanto a edad, sexo, diagnóstico de muerte encefálica y vía crítica del donante. Se trasplantaron un total de 411 órganos procedentes de 147 donantes utilizados; los riñones fueron los órganos obtenidos y trasplantados con mayor frecuencia, ya que supusieron 280 (68,1%) del total de órganos, seguidos del hígado (85, 20,7%), el corazón (31 , 7,5%), los pulmones (14, 3,4%) y el páncreas (1, 0,2%). La tasa de descarte de los donantes fallecidos disponibles fue del 8,1%. Conclusiones. Aproximadamente una décima parte de los donantes son utilizados, de hecho, para realizar trasplantes. Estos datos destacan las áreas en las que se han obtenido buenos resultados y aquellas en las que se presentan desafíos, lo cual proporciona una base para futuras mejoras en Colombia.

ABSTRACT Objective. To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia. Methods. A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described. Results. Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential donor pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%. Conclusions. About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia.

RESUMO Objetivo. Obter uma visão geral e abrangente da doação, do aproveitamento e do descarte de órgãos em todo o processo de doação na Colômbia. Métodos. Estudo retrospectivo de 1 451 possíveis doadores em três regiões da Colômbia que foram avaliados em 2022. Foram descritas as características gerais, o diagnóstico e os motivos para a contraindicação de potenciais doadores. Resultados. Dentre os 1 451 possíveis doadores, 441 (30,4%) preencheram os critérios de morte encefálica, formando o grupo de potenciais doadores. Em 141 casos considerados clinicamente aptos, as famílias consentiram com a doação de órgãos, e em 60 casos utilizou-se o princípio da presunção legal, resultando em 201 doadores elegíveis (13,9%). Desses, 160 (11,0%) foram doadores efetivos (ou seja, doadores nos quais foi feita uma incisão cirúrgica com a intenção de remover um órgão ou pessoas com pelo menos um órgão removido). Por fim, foram identificados 147 doadores utilizados (10,1%) (ou seja, que doaram pelo menos um órgão que foi transplantado). Foram encontradas diferenças estatisticamente significantes entre idade, sexo, diagnóstico de morte encefálica e itinerário crítico de doação entre as regiões. Um total de 411 órgãos foram transplantados de 147 doadores utilizados. Os rins foram os órgãos mais frequentemente removidos e transplantados, representando 280 (68,1%) do total, seguido de 85 fígados (20,7%), 31 corações (7,5%), 14 pulmões (3,4%) e 1 pâncreas (0,2%). A taxa de descarte de doadores falecidos com órgãos removidos foi de 8,1%. Conclusões. Cerca de um décimo dos doadores são efetivamente usados para fins de transplante. Nossos achados destacam áreas de sucesso e desafios, oferecendo uma base para futuras melhorias na Colômbia.

RESUMO Objetivo: Identificar o perfil dos doadores de tecidos oculares humanos na área de atuação do Banco de Olhos da Paraíba, destacando o impacto da sorologia positiva para hepatite B no descarte dos tecidos para transplante. Métodos: O estudo é transversal e utilizou dados do Banco de Olhos da Paraíba entre janeiro de 2013 e dezembro de 2022. Dados sobre procedência, idade, sexo, causa do óbito, tempo entre óbito e enucleação, resultados sorológicos e motivo de descarte das córneas dos doadores foram coletados. Resultados: O maior motivo de descarte foi por sorologia positiva (56,5%), sendo positivadas as sorologias positivas para hepatite B e HBsAg em 11,1% e 4,75% dos pacientes, respectivamente. Conclusão: A sorologia positiva para hepatite B como um critério de descarte absoluto é responsável por grande parcela de descartes, apesar da pouca informação sobre suas repercussões e representação de infectividade nos receptores do transplante.

ABSTRACT Objective: To identify the profile of human ocular tissue donors in the area covered by the Eye Bank of Paraíba (PB), highlighting the impact of positive serology for hepatitis B (anti-HBc) in the disposal of tissues for transplantation. Methods: This is a cross-sectional that uses data from the Eye Bank of Paraíba (PB) between January 2013 and December 2022. Data on origin, age, sex, cause of death, time between death and enucleation, serological results, and reason for discarded donor corneas were collected. Results: The main reason for discarding was due to positive serology (56.5%), with positive anti-HBc and HBsAg serology in 11.1% and 4.75% of patients, respectively. Conclusion: Anti-HBc positive serology as an absolute disposal criterion is responsible for great part of disposals, despite little information about its repercussions and representation of infectivity in transplant recipients.

Abstract Objective Platelet-rich fibrin (PRF) contains a variety of growth factors and bioactive molecules that play crucial roles in wound healing and angiogenesis. We aimed to evaluate the effects of PRF on tissue thickness and vascularization of the palatal donor site by ultrasound (USG) following subepithelial connective tissue harvesting. Methodology A subepithelial connective tissue graft was harvested from the palatal region with a single incision for root coverage in 20 systemically healthy patients. In the test group (n = 10), the PRF membrane was placed at the donor site, whereas no material was applied in the control group (n=10). Palatal tissue thickness (PTT) and pulsatility index (PI) were evaluated by USG at baseline and on the 3rd, 7th, 14th, 30th, and 90th days after surgery. The early healing index (EHI) was used to evaluate donor site healing for 30 days. Results PTT was significantly higher in the PRF group on the 3rd and 14th days after surgery when compared to the controls. In the PRF-treated group, PI levels were significantly higher than in the controls, especially on the 14th day. PTT increased significantly 90 days after surgery compared to the test group baseline, but controls showed a significant decrease. The PRF group showed statistically significant improvements in EHI scores compared to controls on days 3, 7, and 14. This study found a negative correlation between PI values and EHI scores on postoperative days three and seven in the test group. Conclusion USG is a non-invasive, objective method to radiographically evaluate the regenerative effects of PRF on palatal wound healing after soft tissue harvesting. To overcome graft inadequacy in reharvesting procedures, PRF application may enhance clinical success and reduce possible complications by increasing tissue thickness and revascularization in the donor area.

RESUMO As alterações do trato urinário inferior estão diretamente implicadas na etiologia da disfunção renal em 6 a 24% dos pacientes em diálise. Esses pacientes necessitam readequação da capacidade e complacência vesical antes de serem considerados candidatos viáveis para o transplante renal. As cirurgias de ampliação vesical frequentemente envolvem a utilização de segmentos intestinais. Embora estes procedimentos possam reestabelecer de forma eficaz a capacidade e complacência vesical, apresentam diversos problemas relacionados à manutenção da capacidade de absorção e secreção de muco. Acidose, infecções urinárias de repetição e formação de cálculos são extremamente comuns levando a internações frequentes e perda de função do enxerto. O tecido urinário é certamente ideal para estas reconstruções, contudo, ampliações vesicais utilizando ureter e pelve renal são viáveis somente em uma minoria dos casos. Estudos experimentais têm sido conduzidos na busca de se estabelecer os fundamentos para um transplante vascularizado de bexiga. No ano passado, pela primeira vez, este procedimento foi realizado em um paciente em morte encefálica. Nessa intervenção, foi realizada a cistectomia, preservando-se o pedículo vascular, seguida pelo reimplante do órgão. Esse enxerto mostrou-se viável pelo período de 12 horas após o transplante. Entretanto, nesta intervenção, foi utilizada plataforma robótica tornando-o pouco reprodutível em um contexto de captação de múltiplos órgãos bem como para a maioria dos centros transplantadores. Além disso, é discutível se os benefícios do transplante vesical exclusivo compensam os riscos associados à imunossupressão. Para pacientes que precisam ser submetidos a transplante renal e requerem reconstrução do trato urinário inferior, entretanto, a utilização da bexiga do mesmo doador pode representar uma alternativa atraente, evitando as complicações inerentes às enterocistoplastias sem aumento do risco imunológico. O transplante combinado de rim e bexiga tem o potencial de se destacar como a próxima fronteira nos transplantes de órgãos abdominais.

ABSTRACT Lower urinary tract abnormalities are directly implicated in the etiology of renal dysfunction in 6 to 24% of dialytic patients. These patients require bladder capacity and compliance readjustment before being considered viable candidates for renal transplantation. Vesical augmentation surgeries often involve the use of intestinal segments. Although these procedures can effectively restore bladder capacity and compliance, they present various issues related to maintaining mucous absorption and secretion capacity. Acidosis, recurrent urinary tract infections, and stone formation are extremely common, leading to frequent hospitalizations and graft function loss. Urinary tissue is certainly ideal for these reconstructions; however, bladder augmentation using ureter and renal pelvis are feasible only in a minority of cases. Experimental studies have been conducted to establish the groundwork for vascularized bladder transplantation. Last year, for the first time, this procedure was performed on a brain-dead patient. During this intervention, cystectomy was performed with preservation the vascular pedicle, followed by organ reimplantation. The graft remained viable for a period of 12 hours post-transplant. However, this intervention utilized a robotic platform, making it less reproducible in a multi-organ procurement setting as well as for most transplant centers. Moreover, it is debatable whether the benefits of exclusive bladder transplantation outweigh the risks associated with immunosuppression. For patients needing renal transplantation and requiring lower urinary tract reconstruction, however, utilizing the donor’s bladder may offer an attractive alternative, avoiding the inherent complications of enterocystoplasty without increasing immunological risk. Combined kidney and bladder transplantation has the potential to emerge as the next frontier in abdominal organ transplants.

Abstract The clinical literature about the implications of urolithiasis in the process of kidney donation/transplantation (KTx) from deceased donors is scarce. Objectives: To expose the current state of bibliographic production and the clinical implications of urolithiasis in the process of kidney donation/transplantation focus on cadaveric donor grafts. Methods: We performed a bibliometric analysis based on a systematic review of the literature in Medline, Embase, SciELO, Cochrane Central, Google Scholar and Web of Science using combinations (OR, AND) of MesH terms: "urolithiasis""kidney calculi", "ureteral calculi", "tissue and organ procurement", "brain death", "living donors"and "kidney transplantation". The search was limited to primary articles, systematic reviews or meta-analyses performed in humans published between 2000-2022. Results: Twenty-three articles were included for analysis; 95.6% of the bibliographic production was published in English, 26% were published into quartile 1 journals. One third of the references were focused on cadaveric donors. The information obtained concludes that presence of urolithiasis in the kidney graft is not an absolute contraindication for KTx and proposes the ex vivo surgical management of urolithiasis during the bench surgery for stones > 4 mm and to proceed with KTx and then follow-up for kidney grafts with stones < 4 mm. Conclusions: The scientific production related to urolithiasis and kidney donation/transplantation is limited. The literature available concludes that incidental kidney stones in kidney grafts should not be considered an absolute contraindication for KTx. Ex vivo surgical management of urolithiasis is a feasible and safe prior to KTx.

Resumen La literatura disponible sobre las implicaciones de la urolitiasis en la donación y trasplante renal (TxR) con injertos de donante cadavérico es limitada; la información disponible tiene especial énfasis en el donante vivo. Objetivo: Exponer la producción bibliográfica y las implicaciones clínicas de la urolitiasis en el proceso de donación y TxR incluyendo la perspectiva con injertos de donante cadavérico. Métodos: Análisis bibliométrico ejecutado mediante una búsqueda sistemática de la literatura en Medline, Embase, SciELO, Cochrane Central, Google Académico y Web of Science utilizando combinaciones de los términos MesH "urolithiasis", "kidney calculi", "ureteral calculi", "tissue and organ procurement""brain death", "living donors"y "kidney transplantation" Se limitó la búsqueda a artículos publicados entre los años 2000-2022. Resultados: Se analizaron 23 artículos. El 95.6% de ellos fueron publicados en inglés, el 26% se publicaron en revistas del cuartil 1, solo un tercio de ellos tienen relación con el donante cadavérico. La urolitiasis en el injerto renal no es una contraindicación absoluta para el trasplante, se puede ofrecer manejo quirúrgico activo ex vivo durante la cirugía de banco para cálculos > 4 mm y el trasplante con observación para injertos renales con cálculos < 4 mm. Conclusiones: La producción científica en términos de litiasis urinaria y donación/TxR es limitada. El hallazgo incidental de urolitiasis en el donante vivo o cadavérico de riñón no es una contraindicación absoluta trasplante. El manejo quirúrgico ex vivo es una opción factible y segura para manejar la litiasis urinaria antes del trasplante.

Resumen Introducción: El proceso de donación de órganos y tejidos se define por las acciones encaminadas a transformar a una persona donante potencial (DP) en donante efectiva. Este proceso comienza con el diagnóstico de muerte encefálica. Objetivo: Analizar el perfil clínico y sociodemográfico de potenciales donantes de órganos, así como los factores que influyen en la donación de órganos. Métodos: Se trata de una investigación cuantitativa, transversal, retrospectiva y analítica realizada a partir de la recopilación de datos de 455 prontuarios de pacientes con diagnóstico de muerte encefálica, en una región del Nordeste de Brasil, utilizando un formulario estructurado. Posteriormente, se realizaron análisis descriptivos y, en las asociaciones entre las variables independiente y dependiente, se utilizó la prueba chi-cuadrado de Pearson Resultados: Los grupos de edad con mayor incidencia fueron de 21 a 40 años y de 41 a 60 años, con un 33.8 % cada uno, con predominio del sexo masculino (64.1 %). En cuanto a la causa de muerte, predominó el trauma craneoencefálico con un 36.5 %. Se entrevistó al 83.3 % de familiares y, de este grupo, el 53.5 % autorizó la donación. En cuanto a la relación entre las respuestas de las entrevistas a familiares y el sexo del TP, se destacó el sexo masculino con un 59.01 % de las entrevistas positivas; en cuanto a la entrevista y grupo de edad no se encontraron diferencias significativas. Correlacionando los resultados de las entrevistas familiares y la causa de muerte, el 40.63 % fue por trauma craneoencefálico y, de ese total, el 63.63 % tenía autorizada la donación. Conclusión: Los donantes más efectivos fueron jóvenes y varones, con predominio del traumatismo craneoencefálico como causa de muerte encefálica y aceptación familiar de la donación.

Resumo Introdução: O processo de doação de órgãos e tecidos é definido por ações a fim de transformar um Potencial Doador (PD) em doador efetivo e inicia-se com o diagnóstico de morte encefálica. Objetivo: Analisar o perfil clínico e sociodemográfico dos potenciais doadores de órgãos, como também os fatores que influenciam na doação de órgãos. Métodos: Trata-se de uma pesquisa quantitativa, transversal, retrospectiva e analítica realizada através da coleta de dados de 455 prontuários de pacientes com diagnóstico de Morte Encefálica, de uma Região do Nordeste brasileiro, utilizando formulário estruturado. Posteriormente realizaram-se análises descritivas e nas associações entre as variáveis independentes e dependente, utilizou-se o teste qui-quadrado de Pearson Resultados: As faixas etárias de maior incidência foram entre 21 a 40 anos e 41 a 60 anos, com 33,8% cada, prevalecendo o sexo masculino (64,1%). Em relação à causa da morte, predominou o Trauma Cranioencefálico com 36,5%. Foram entrevistados 83,3% dos familiares e desses, 53,5% autorizaram a doação. Quanto à relação das respostas das entrevistas com os familiares e o sexo dos PD o sexo masculino se destacou com 59,01% das entrevistas positivas, quanto a entrevista e faixa etária, não foram encontradas diferenças significativas. Correlacionando o resultado das entrevistas familiares e a causa da morte, 40,63% destas tinham como causa o trauma cranioencefálico, e desse total, 63,63% tiveram a doação autorizada. Conclusão: A maioria dos doadores efetivos foram jovens e do sexo masculino, com prevalência do trauma craneoencefálico como causa da morte encefálica e da aceitação familiar para a doação.

Abstract Introduction: The process of organ and tissue donation is defined by actions to transform a Potential Donor (PD) into an effective donor and begins with the diagnosis of brain death. Objective: To analyze the clinical and sociodemographic profile of potential organ donors, as well as the factors that influence organ donation. Methods: This is a quantitative, cross-sectional, retrospective, and analytical research carried out in a region of Northeast Brazil by collecting data from 455 medical records of patients with brain death, who were diagnosed using a structured form. Subsequently, descriptive analyzes were carried out and for the associations between the independent and dependent variables, the Pearson's chi-square test was used. Results: The age groups with the highest incidence were between 21 to 40 years old and 41 to 60 years old, with a 33.8 % each, with a predominance of males (64.1%). Regarding the cause of death, traumatic brain injury was the most common with a 36.5% of the sample. From the 83.3% of the family members that were interviewed, 53.5% of them authorized the donation. Male potential donors constituted the 59.01% of the authorized donations (positive interviews). There was no relationship between the interview results and the age group of the PD. When correlating the results of family interviews and the cause of death, 40.63% of them were caused by traumatic brain injury and, out of this total, 63.63% had the donation authorized. Conclusion: The most effective donors were young and male whose cause of brain death was traumatic brain injury and whose families allowed the donation.

RESUMO A degradação do intestino delgado de bovinos e seu efeito biomecânico não são descritos na literatura. Trabalhos que envolvem a biomecânica intestinal realizam os ensaios em poucas horas após o óbito dos doadores, sem avaliação de seu estado de deterioração. O congelamento é eficiente na conservação de vários tecidos, porém pode provocar danos em nível celular. Este estudo teve por objetivo avaliar a degradação morfológica e biomecânica do jejuno de bovinos em diferentes tempos post mortem. O efeito do congelamento e do descongelamento sobre essas características também foi avaliado. As primeiras alterações macroscópicas foram observadas oito horas após o óbito. No mesmo momento, se iniciaram as alterações histológicas e a menor pressão suportada ao teste biomecânico (203,10±46,14mmHg). A partir de 12 horas, o tecido sofreu um rearranjo, suportando maior pressão (238,43±31,04mmHg). Uma segunda queda foi detectada após 18 horas (235,20±38,21mmHg), seguida de redução progressiva até o término do experimento. As lesões histológicas foram progressivas e graduais. As amostras testadas após descongelamento não apresentaram diferença estatística quanto à resistência mecânica em comparação com os espécimes frescos. Concluiu-se que as amostras mantêm sua resistência biomecânica até 6 horas após o óbito. Também se mostrou que o congelamento e o descongelamento, nas condições testadas, não alteraram a resistência mecânica da parede intestinal. literatura doadores deterioração tecidos celular mortem avaliado momento 203,10±46,14mmHg. 203104614mmHg mmHg 203,10±46,14mmHg . 203 10 46 14mmHg (203,10±46,14mmHg) 1 rearranjo 238,43±31,04mmHg. 238433104mmHg 238,43±31,04mmHg 238 43 31 04mmHg (238,43±31,04mmHg) 235,20±38,21mmHg, 235203821mmHg 235,20±38,21mmHg , 235 20 38 21mmHg (235,20±38,21mmHg) experimento graduais frescos Concluiuse Concluiu 4 (203,10±46,14mmHg 23 3 (238,43±31,04mmHg 2 (235,20±38,21mmHg

ABSTRACT Degradation of bovine small intestine and respective effects on biomechanics have not been described to date. Biomechanical testing of intestinal tissues is often carried out within a few hours of donor death and tissue deterioration is not accounted for. Freezing is efficient for the preservation of several tissues; however, it may cause cellular damage. This study investigated the morphologic and biomechanical changes of bovine jejunum at different postmortem moments. Effects of freezing and thawing on morphology and biomechanical behavior were also examined. Macroscopic changes were first noted within eight hours of death. At this time, histologic changes also started to set in, and biomechanical tests revealed lower bursting pressure (203.10±46.14mmHg). At 12 hours, tissue rearrangement was noted, and bursting pressure increased (238.43±31.04mmHg). A second drop in pressure was detected at 18 hours (235.20±38.21mmHg), followed by a progressive drop until the end of the experimental period. Histologic changes revealed progressive deterioration. Mechanical resistance did not differ between thawed and fresh specimens. It was concluded that bovine jejunal specimens retain biomechanical resistance up to 6 hours after death. Freezing and thawing did not affect the mechanical resistance of the intestinal wall in this experimental model. date however damage moments examined time 203.10±46.14mmHg. 203104614mmHg mmHg 203.10±46.14mmHg . 203 10 46 14mmHg (203.10±46.14mmHg) 1 238.43±31.04mmHg. 238433104mmHg 238.43±31.04mmHg 238 43 31 04mmHg (238.43±31.04mmHg) 235.20±38.21mmHg, 235203821mmHg 235.20±38.21mmHg , 235 20 38 21mmHg (235.20±38.21mmHg) period model 4 (203.10±46.14mmHg 23 3 (238.43±31.04mmHg 2 (235.20±38.21mmHg

Resumen Introducción: Los arrecifes de coral son ecosistemas altamente degradados, por lo que ha sido necesario implementar acciones de restauración activa para recuperar su estructura y funcionamiento. Se ha implementado la propagación clonal para obtener fragmentos pequeños (~ 10 cm) de las ramas distales de colonias donadoras de corales de la especie Acropora palmata, para posteriormente fijarlos en el sustrato arrecifal, simulando el efecto de dispersión que ocurre de manera natural en esta especie, a lo que en este trabajo se denomina ''dispersión asistida”. Sin embargo, es necesario evaluar los efectos de esta técnica como son: la cantidad de fragmentos que se puede obtener de cada colonia, el periodo de recuperación de tejido de las colonias donadoras y los fragmentos sembrados. Objetivo: Evaluar el efecto de poda en las colonias donadoras estimando el porcentaje de tejido podado de colonias donadoras de A. palmata y su tasa de recuperación 30 meses después. Métodos: Se realizaron cuatro monitoreos: antes, inmediatamente después de la poda, un mes después de la siembra, y 30 meses después, en cuatro colonias de A. palmata localizadas en el Parque Nacional Costa Occidental de Isla Mujeres, Punta Cancún y Punta Nizuc en el Caribe mexicano. La modelación 3D basada en fotogrametría se realizó con el software Agisoft Metashape Pro, mientras que las métricas de área de superficie de tejido, extensión radial y apical se obtuvieron mediante el software CloudCompare. Resultados: Posterior a la colecta de fragmentos de las colonias, se observó que el material utilizado en la dispersión asistida representa menos del 12% del tejido vivo. Después de un mes, las colonias donadoras presentaban una recuperación del 5% con tejido nuevo recubriendo las áreas de corte. Las colonias donadoras perdieron, en promedio, 65% de tejido vivo tras el impacto de cuatro huracanes, y en un caso la colonia fue totalmente eliminada, pero con los fragmentos sembrados se pudo conservar el genotipo. Conclusiones: La dispersión asistida podría incrementar el tejido vivo de corales ramificados en intervalos de tiempo relativamente cortos, sin comprometer la integridad de la colonia donadora, si se poda menos del 12%.

Abstract Introduction: Coral reefs are highly degraded ecosystems, for which it has been necessary to implement active restoration actions to recover their structure and functioning. Asexual propagation has been implemented to obtain small fragments (~10 cm) from the distal branches of donor colonies of corals of the species Acropora palmata, to subsequently relocate them in the reef substrate, simulating the dispersion effect that occurs naturally in the species, which in this work is called assisted propagation. However, it is necessary to evaluate the effects of this technique, such as the number of fragments that can be obtained from each colony, the tissue recovery period of the donor colonies and fragments. Objective: To address the effect of pruning on donor colonies by estimating the percentage of live tissue removed from donor colonies of A. palmata and their recovery rate after 30-months. Methods: Four surveys were carried out: before, immediately after pruning, one month after outplanting, and 30 months after pruning on four colonies of A. palmata located in the Parque Nacional Costa Occidental de Isla Mujeres, Punta Cancún and Punta Nizuc in the Mexican Caribbean. Photogrammetry-based 3D modeling was performed using Agisoft Metashape Pro software, while tissue surface area, radial and apical growth were obtained using CloudCompare software. Results: After fragment collection, the material used in the assisted propagation represents less than 12% of the living tissue. After one month, the donor colonies showed a recovery of 5%, with new tissue covering the cut areas. The donor colonies lost on average 65 % of living tissue after four hurricanes, and in one case the colony was lost all together, but with the outplanted fragments the genotype could be preserved. Conclusions: Assisted propagation could increase living tissue of branching corals in relatively short intervals of time, without serious damage to the donor colony if less than 12 % is removed.